a question for dr.Bob and experts...

Posted by Erich on December 26, 1998, at 11:51:40

I'd try to be as brief as I can: I' m in a dramatic situation. 6 years ago I fell in a deep anxious major depression due to repetition stresses/failures concurrent the decision to change field of study (I m graduating in mathematics soon).This depression showed to be resistent to triciclics and triciclics/SSRI combinations. After one year suffering, I tried phenelzine 90 mg/d and it was effective. I knew about MAOI's 'tolerance' effect: for some months my depression was (partially) under controland phenelzine was very gradually lowered to 30 mg/d. Some months later full depressive symptoms came back. It was sufficent to double at 60 mg/d to partially control it once more. I introduced sodium valproate to augment phenelzine. Nevertheless I started curiously cyclying!!!Curiously I said, because i m not a bipolar and when I feel better (never more than a month continuously actually!) that only means depressive symptoms are partially under control and life is tolerable, while when I go down to a full depressive condition suffering makes my life untolerable: I used to modify doses during the depressive periods (lasting from a few days up to more than a month) so that I m not sure that remissions from those periods had ever been spontaneous or pharmacological!All these facts leads to a question I need help to answear to: how come this strange cycling???? Cycling is not anymore tolerable, so that nomore than 2 weeks ago I was close to decide for suicide. I instead highed phenelzine up to 90 and sodium valproate to 1200 mg/d. I succeeded in feeling a bit better one more time: I felt confused on what to do....I decided ( don t ask me why....) to lower phenelzine down rapidely leaving sodium valproate unchanged... now I m at 30 mg/d phenelzine... anxious symptoms got back from some days (hard continuous headache: I started analgesics to control it, peripherical tension, etc...) Maybe I wanted to know how was my depression after these years with no phenelzine in my body.... in any case I stopped reducing... I was afraid to get back to full depressive symptoms....I m confused .... what should I do??? Now my questions to you is:How would u explain these cycliings?If there was a patient of yours, whose case was as much similar as u can imagine to the description I made of it, how would you manage now in the therapy? (ex:switch to another antidep, take off phanelzine, augment phenelzine,....)